Deck 1

Question 1

Treatment for SBP with renal failure

Answer 1

Intravenous albumin with antibiotic therapy

Question 2

Intermediate risk cardiovascular patient asymptomatic next test performed

Answer 2

High sensitivity CRP can help reclassify patients with intermediate risk to either low or high

Question 3

Bicuspid aortic valve patient with symptomatic aortic regurgitation and a sending aortic diameter greater than 45 mm

Answer 3

Aortic valve replacement and aortic root graft placement

Question 4

Rhandomyositis from cyclosporine and statins in heart transplant patient - myalgia and elevated creatinine kinase

Answer 4

Calcium channel blockers, antifungal agents, antimicrobial agents, antiseizure medication

Question 5

Asymptomatic patient was exposed pacemaker through skin minimal erythema no signs of infection

Answer 5

Extract device and leads

Question 6

Leading cause of death in women

Answer 6

Coronary artery disease

Question 7

Side effect of Dronedarone

Answer 7

Reduced creatinine clearance but does not decrease kidney function - contraindicated in decompensated heart failure

Question 8

Symptomatic severe heart failure on beta blocker ace inhibitor and diuresis
-what to add next

Answer 8

Spironolactone - rales study

Or epleronone

Question 9

NSTMI patient with high TIMI risk score started on heparin Plavix metoprolol sublingual nitro aspirin what else to add

Answer 9

Add Staten and GP IIb/IIIa inhibitor

Question 10

Treatment for recurrent pericarditis

Answer 10

Aspirin plus colchicine - don’t use steroids because they cause recurrence

Question 11

Treatment for atrial myxoma asymptomatic patient

Answer 11

Surgical resection

Question 12

Chest pain in woman with interpretable EKG with intermediate risk of coronary artery disease

Answer 12

Exercise EKG stress test

Question 13

Dyspnea, pedal edema, clear lungs, JVD with inspiration, cardiac CT pericardial thickening, ventricular interdependence, to and fro diastolic motion of ventricular septum, kusmal sign

Answer 13

Constrictive pericarditis

Question 13

Management of symptomatic atrial fibrillation in setting of structural heart disease or heart failure

Answer 13

Amiodarone or dofetilide - can’t use negative Ionotropes or beta blockers

Question 14

Ascending aortic dissection management

Answer 14

Emergency surgery - May not always have difference in left and right arm blood pressure

Question 15

Single vessel disease asymptomatic now what will give the patient the greatest reduction in risk of MI

Answer 15

Aggressive risk factor reduction such as the addition statin

Question 16

When to get in at go with asymptomatic heart murmurs

Answer 16

Systolic murmurs greater than three out of six or any diastolic or continuous murmurs

Question 17

Restrictive cardiomyopathy

Answer 17

Infiltration from iron like in hemochromatosis amyloidosis sarcoidosis postradiation fibrosis of myocardium Loeffler syndrome

Question 18

Constrictive pericarditis

Answer 18

Uniform diastolic pressures and all chambers caused by radiation, postinfection, postsurgical, connective tissue disorder, uremia, sarcoid

Question 19

Severe symptomatic aortic’s to gnosis with abnormal ventricular function next step

Answer 19

Surgical aortic valve replacement if patients good operative candidate if not then Transcatheter aortic valve implantation

Question 20

Peripartum cardiomyopathy therapy

Answer 20

During pregnancy should be treated with beta blockers, digoxin and diuretics and after delivery should add ace inhibitor

Question 21

Patient with Hodgkins disease with prior radiation therapy and chemotherapy including doxorubicin with shortness of breath

Answer 21

First ruleout cardiomyopathy with transthoracic echocardiogram then consider exercise EKG stress testing to rule out ischemic disease which can be accelerated patients that underwent mantle radiation

Question 22

Atrial septal defect

Answer 22

Fixed split S2, mitral regurgitation murmur, left axis deviation, first-degree AV block, intraventricular conduction delay

Question 23

Symptomatic pulmonary valve stenosis or patients with severe pulmonary valve stenosis without symptoms

Answer 23

Pulmonary balloons out of your plaster you in patients with pulmonary valve stenosis with peak gradient greater than 50 and less than moderate pulmonary valve regurgitation - pulmonary vasodilator therapy would not be helpful with pulmonary valve stenosis -surgery only with patients with hypoplastic call Marianne illness, some valvular or supravalvular pulmonary stenosis or severe pulmonary valve regurgitation

Question 24

Post infarction VSD

Answer 24

New holosystolic murmur with palpable thrill with hypotension and tachycardia

Question 25

Cardiovascular risk assessment in young woman

Answer 25

Reynolds risk score better for young women versus Framingham risk score

Question 26

Hemodynamically stable wide complex tachycardia - in patient with known coronary artery disease should be assumed to be ventricular tachycardia

Answer 26

Intravenous antiarrhythmic agents such as amiodarone procainamide sotalol and as a second line lidocaine - if does not work elective cardioversion can be used - do not use verapamil or beta blockers

Question 27

Eisenmenger syndrome

Answer 27

Cyanotic congenital disease characterized by irreversible pulmonary vascular disease from atrioventricular septal defect showing cyanosis right ventricular hypertrophy decrease pulmonary vascularity, and large central pulmonary arteries, associated with down syndrome

Question 28

Two strongest risk factors associated with myocardial infarction

Answer 28

Smoking and dyslipidemia

Question 29

Pregnant woman with mechanical heart valves

Answer 29

warfarin - though can cause teratogenicity, miscarriage, fetal loss, increased fetal risk is only option with mechanical valve

Question 30

Life-threatening diagnoses with chest pain in the emergency room

Answer 30

Pulmonary embolism, aortic dissection, acute coronary syndrome, pericardial tamponade, pneumothorax, esophageal rupture

Question 31

Hypertrophic cardiomyopathy

Answer 31

Dynamic left ventricular outflow tract obstruction, systolic murmur decreased by handgrip which increases after load and increased by maneuvers decreasing preload like Valsalva also asymmetric septal hypertrophy and small ventricular cavity and enlarged left atrium

Question 32

Anticoagulation after atrial fibrillation ablation

Answer 32

All patients should be on Coumadin for first to get three months then you should be anticoagulated as if oblation never occurred - use CHADS2 score

Question 33

Cholesterol embolization syndrome

Answer 33

Red to purple to blue discoloration of toes livedo reticularis signs of systemic illness elevated white count elevated ESR elevated creatinine

Question 34

Tetralogy of fallot repair

Answer 34

Often have pulmonary valve regurgitation and require pulmonary valve replacements and tricuspid valve repair from right-sided chamber enlargement as well as maze procedure for a afib developed

Question 35

Unstable angina in patients with contraindication to beta blockers

Answer 35

Use calcium channel blockers when blockers are contraindicated

Question 36

SVT not terminated by adenosine

Answer 36

Likely atrial tachycardia

Question 37

Peripheral arterial disease with borderline resting ABI

Answer 37

Check exercise ABI

Question 38

Treatment for PJP pneumonia

Answer 38

Bactrim and if hypoxic or PaO2 less than 70 or AA gradient greater than 35 then at steroids

Question 39

HIV-AIDS patients exposed to patient with TB

Answer 39

Treat patients like latent TB because patient with AIDS can have negative tuberculin skin test despite real exposure

Question 40

Life-threatening candidemia

Answer 40

Treat with echinocandin ie caspofungin - can switch to fluconazole when stabilized -don't use amphotericin B if patient in renal failure

Question 41

Recurrent mild to moderate C diff

Answer 41

Can repeat Flagyl 14 day course if my out to moderate c diff again - this is not resistance but hatching of spores present on initial infection - if recurrent severe then treat with prolonged vancomycin taper

Question 42

Primary genital herpes simplex infection - painful the vesicular lesions with erythematous base as well as malaise fevers - chronic suppression therapy with Valacyclivir

Answer 42

Empiric acyclovir here valacyclovir here or famciclovir

Question 43

Candida vaginitis with fissures and excoriations from pruritis

Answer 43

Single dose from fluconazole

Question 44

Histoplasmosis

Answer 44

Ohio Valley with bats - acute pulmonary symptoms fever headache cough shortness of breath chest pain, hilar lymphadenopathy and interstitial infiltrates

Question 45

Blastomycosis

Answer 45

No hilar lymphadenopathy - soil exposure wood products - Great Lakes Mississippi River Valley Eastern North America - acute pulmonary infection flulike symptoms cough chest pain

Question 46

Coccidiomycosis

Answer 46

Southwest United States farming soil handling - flulike illness the kid pulmonary infection arthralgia maculopapular rash and erythema Nodosum

Question 47

Prosthetic joint infection

Answer 47

If no further surgery then lifelong therapy with Bactrim

Question 48

Hemorrhagic colitis

Answer 48

Shiga toxin producing E. coli - Gross blood uncooked hamburger

Question 49

Campylobacter jujuni

Answer 49

Preformed toxin symptoms occur less than 24 hours after ingestion with nausea vomiting diarrhea but no blood

Question 50

Shigellosis with diarrhea now resolved but patient works in day care setting

Answer 50

Empiric Treatment with ciprofloxacin indicated as patient in either food service industry or childcare center where infection may spread

Question 51

Vancomycin intermediate methicillin-resistant staph aureus bacteremia

Answer 51

Daptomycin is recommended for treatment when staff aureus partially resistant to vancomycin mic >2

Question 52

Cervicitis - Mucopurulent cervicitis caused by gonorrhea and chlamydia with leukocytes elevated pH negative with test

Answer 52

Ceftriaxone IM and azithromycin orally | For chlamydia

Question 53

Pelvic inflammatory disease must have cervical motion tenderness

Answer 53

Cefoxitin plus doxycycline

Question 54

Tuberculous screening in patients that received BCG cancer therapy or vaccine

Answer 54

Interferon gamma release assay

Question 55

Human bites injury prophylaxis - Strep , staph, eikenella, anaerobes

Answer 55

Augmentin and if penicillin allergic then clindamycin and moxifloxacin

Question 57

Varicella prophylaxis patient with leukemia or immunocompromise

Answer 57

Varicella zoster immune globulin

Question 58

Bicuspid aortic valve patient with symptomatic aortic regurgitation and a sending aortic diameter greater than 45 mm

Answer 58

Aortic valve replacement and aortic root graft placement